Healthcare Provider Details

I. General information

NPI: 1427880830
Provider Name (Legal Business Name): MICHAL TOMASZ WOJDYGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6043 WINTHROP COMMERCE AVE STE 201
RIVERVIEW FL
33578-4274
US

IV. Provider business mailing address

6318 HAVENSPORT DR
APOLLO BEACH FL
33572-1774
US

V. Phone/Fax

Practice location:
  • Phone: 813-291-0629
  • Fax:
Mailing address:
  • Phone: 561-859-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11030643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: